Year of Publication

2017

College

Public Health

Date Available

2-15-2017

Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Member

Philip Westgate, PhD

Advisor

Wayne T. Sanderson, PhD

Co-Director of Graduate Studies

Thomas Tucker, PhD

Abstract

Introduction: In 2016 there will be an estimated 76,380 new cases of malignant melanoma and 10,130 deaths in the United States (US). 1 Malignant melanoma incidence is increasing faster than any other preventable cancer in the US with an expected 112,000 new cases a year by 2030. 2,3 This capstone attempts to quantify the association of individual and social factors on melanoma late-stage diagnosis and non-adherence to surgical treatment guidelines for early-stage lesions in Kentucky.

Methods: The analysis combines three datasets: individual level data from the Kentucky Cancer Registry, census tract level data from the US Census and county level physician licensure data from the Kentucky Department of Public Health. Descriptive statistics, univariate and multivariate logistic regression analyses were completed.

Results: The first paper hypothesized that late-stage diagnosis is associated with an increase in poverty level, decrease in education level and decrease in physician density. An association between these variables of interest were not found, rather, this study supports previous research that there is decreased odds of late-stage diagnosis if female, married and carry private insurance. 65,123,125 The second paper hypothesized that non-standard treatment more frequently occurs in rural and Appalachian regions and geographic areas with lower physician density and lower socioeconomic status as indicated by an increase in poverty level and decrease in education level. An association between nonstandard treatment and Appalachian geography, poverty level and physician density was found. Non-standard treatment was provided to 40% of early-stage cases and this rate is rising.

Conclusions: Kentucky is a rural state with high poverty, lower than average education levels and low physician density but it appears that these factors have not impacted melanoma stage of diagnosis. Instead, policy implementation should focus on the need to increase patient access to melanoma care and educating clinicians to halt the trend of increasing non-standard melanoma surgical treatment for early-stage lesions in the Commonwealth.

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